Bates' Advanced Physical Assessment Question Bank (Chapters 18-27)

Bates' Advanced Physical Assessment Question Bank (Chapters 18-27)

Chapter 18: Breasts and Axillae
1. A 42-year-old female website developer presents for an annual preventive examination with
questions about breast cancer screening. She is concerned about the radiation exposure associated with
mammography and is interested in magnetic resonance imaging (MRI) as a possible alternative for
routine screening. She is otherwise healthy with no family history of breast, ovarian, or colon cancer.
Which of the following is true about MRI as a screening modality for breast cancer in the general
population?
a. Breast cancer screening by MRI has been well studied in the general population.
b. Sensitivity of screening for breast cancer increases with breast MRI at the expense of specificity.
c. This patient is an ideal candidate forscreening via breast MRI based on current evidence
d. Women at low lifetime risk of breast cancer (<20%) are recommended to undergo screening MRI.
e. Known BRCA1 or BRCA2 mutation is insufficient criteria to justify screening with breast MRI.
2.A 44-year-old female mathematician presents to clinic with a complaint of a mass in the right breast.
Her partner noticed this mass 2 days ago, and the patient feels guilty because she has only had one
mammogram and does not engage in breast self-examination (BSE) on any regular basis. She has no
family history of breast cancer, and her prior mammogram was ordered as a routine screening test at
age 43 years after a brief discussion with her primary care provider. After a thorough investigation
reveals a benign cyst, what advice should be given to this patient about screening for breast cancer in
her age group?
a. BSE is well evidenced, and all recommending agencies agree that it should be taught and reinforced.
b. Clinical breast examination (CBE) is superior to BSE and should be a routine part of annual
examinations starting at age 30 years.
d. Mammography is most sensitive and specific for women in their 40s, when breast tissue is still dense
enough to image accurately.
e. Breast cancer screening is extremely well studied, and no controversy exists on the recommended
norms for screening and follow-up.
3. A 35-year-old G0P0 woman presents to clinic with a complaint of bilateral nipple discharge. This
discharge started several weeks ago and has occurred at irregular intervals since that time. She does not
complain of local tenderness, redness, fever, or any other systemic symptoms aside from slightly
irregular periods over the last few months. On examination, she is able to express a small amount of
discharge, which is sent to the laboratory and found to be consistent with breast milk but without any
signs of blood or pus. Screening laboratories are also sent, which reveal a normal blood count, metabolic
panel, thyroid-stimulating hormone, and human chorionic gonadotropin (HCG) level. Further
laboratories are still pending. Which of the following is the most likely diagnosis?
c. This patient was in compliance with the U.S. Preventive Services Task Force (USPSTF)
recommendations for her age group and risk factors prior to her current complaint.
a. Mastitis
b. Ductal carcinoma in situ
c. Paget disease of the breast
d. Occult pregnancy
e. Prolactinoma
4. A 22-year-old G0P0 undergraduate student presents to clinic after finding a breast mass on breast
self-examination (BSE) at home. The mass is nontender without skin changes, erythema, or overlying
swelling. She has heard that most breast cancers are found by patients themselves, and she is very
concerned that she may have breast cancer. Which of the following is true about BSE and self-detection
of breast cancer?
a. Most masses that women find at home and bring to a provider’s attention turn out to be malignant.
b. This patient is more likely to find a fibroadenoma than a cancer on self-examination.
c. The most likely breast mass this patient is likely to find in herself is an abscess complicating underlying
mastitis.
d. Because of this patient’s age, breast masses should not be pursued with imaging and diagnosis
because the risk of cancer is so low.
e. BSE is universally recommended because of very high sensitivity and specificity for finding cancerous
lesions.
5. A 48-year-old female psychologist presents to clinic with concerns about her breast cancer risk after
an age-matched cousin was recently diagnosed with this disease. This cousin is the third family member
on her father’s side in as many years to be diagnosed with breast cancer, including the patient’s own
father, who had surgery and subsequent treatment 3 years ago for breast cancer. The patient has little
other knowledge of her family history, only that her grandparents independently arrived from Eastern
Europe near the end of World War II and were among very few members of their family that survived
the war. The patient has read about testing for the breast cancer genes (BRCA1 and BRCA2) and desires
further information about whether this would be appropriate for her. Which of the following is true
about this patient’s indications for BRCA testing?
a. Her familial lineage is irrelevant to her risk of BRCA genes and should be discounted in assessing her
risk for these genes.
b. Breast cancer in a male relative does not add significant weight to the decision to test for the BRCA
genes in this patient.
c. The BRCAPRO calculator does not add any further clinical information to this patient’s risk for carrying
the BRCA gene.
d. This patient carries several risk factors that together justify BRCA testing.
e. Even if this patient is BRCA positive, no changes in screening or treatment are recommended for
patients with this genetic mutation, so the test is not recommended